3c degree tear last time...WWYD

[sianyb83]

6 years ago I had my DS, it was a long labour (31hours), he was back to back and I ended up with a cervical lip due to pushing to early and then in theatre for a instrumental delivery. They tried ventouse, which didn't work, so they then used forceps which finally did the trick - but just when I thought we were out of the woods I had a large haemorage (2.1litres). The aftermath was a 3c tear - which I only found out about at my booking in appointment (with current pregnancy - I thought it was a second degree episiotomy).

I'm now 27 weeks, and had a consultant app a few weeks ago. I was surprised she wasn't worried about the haemorrage at all - but was worried that I may tear again, and it could cause bladder or bowel incontinence. Her advice was to consider a c-section, which is pretty much my greatest fear.

I had a few issues with my bowels last time, nothing too major and it seemed to resolve itself within about 6 months.

Half of me is optimistic next time will be easier, or at least quicker - I'll be calmer and less chance of baby being back to back second time (I think!) I know I'll likely tear again - which I don't mind, I just hope it won't be as bad.

I'm afraid of a c-section, but know it would be a more controlled option - what would you do?

C-section every single time.

I can only imagine that being left with a lifetime of fecal or urinary incontinence would be far more damaging to health, meaning on going discomfort, misery and resulting in care (if you get any on the NHS!), treatment and potential further surgery.

If I were facing that risk, I would have a section in a New York second.

And I'm sorry you had such a difficult time with your first

My first labour resulted in similar damage in that I had a 3rd degree tear and had a huge post partum haemorrhage. The birth was pretty uncomplicated in that it was a 7 hour water birth but anyway...
The advice from the consultant when I had the follow up meeting (and he was a leading UK expert in 3rd degree tear repairs) was to have an elective cs for any subsequent births. He said the likelihood of having a similar tear was very high and the repair success rate was significantly lower. Since the tear I had no complications, all bladder control etc but he gave a stark warning that if it were to happen again I'd be wearing adult nappies by my fifties.
Funnily enough I went for the elective CS and it was the best decision - calm, ordered and a minimal scar that you can barely see 4 years later. I'd do some research on it but would follow the advice of your consultant if he recommends a caesarean.

@strokethefurrywall

Thanks for your advice, a lot of my friends are hypnobirthing types so I feel they're a bit dismissive when I talk about it!
It doesn't help that I was on oral morphine for 6 days after his birth so its all a bit of a blur!

I think I need to get my head around c-section idea, it terrifies but I think I am basing that on stories of emergency c-section, not planned.

My consultant has been fantastic, she said I would be supported with either choice but did seem to lean towards c-section.

Sorry for TMI, but I pooed myself 6-8 times within the first 6 months of having DS, and then had leaking until about 9 months - once I told her about that she said risk of reoccurrence would be higher, and it could happen again.

I was told that just because you tear with your first you won't necessarily tear with your second. It doesn't increase the likelihood at all. I had a 3rd with my first and a tiny tear with my 2nd which I barely even noticed. I wouldn't want a c-section. It's major abdominal surgery and carries many of its own risks including increased recovery time which would worry me even more, especially if I had a young child already.

I was a hypnobirthing type but I understand that I was fucking lucky that DS1 was in the optimum position, and I delivered him in 4 hours start to finish.

DS2 was an epidural birth due to decels at 30 weeks so needed to be closely monitored and numb in case OBGYN needed him out fast.

I, like you, was terrified of having a section but I know so many friends who had ELCS with their first and opted for the ELCS with the second because they had such a positive experience.

I would have thought that having to have a crash section would be far more damaging emotionally and physically than an elective section where your consultant can take their time to help you bring your baby into the world, and it's likely that your recovery from a section would be far quicker and less uncomfortable than what you went through the last time.

Yes, a section is surgery. But I would choose a surgery and the relatively small risk it carries, over the greater risk that my body may be subjected to very serious and irreversible damage.

I had a 3b tear with my first, was offered physio and scans afterwards. Like you I had some incontinence but physio helped, still get the odd urgency now and again. I think it's shocking this wasn't offered to you! Anyway, just given birth to my second via elcs. It was the consultant I saw after having my first who suggested an elcs so mentally I had prepared myself for this knowing that I wanted another child. I opted for the elcs because I didn't want long term problems with incontinence, I wouldn't have been able to forgive myself if I had another VB and ended up with further damage down below!

I just wanted to add that I had a grade 4 tear first time and elective c section second time, elective section was an absolute dream in comparison, really smooth recovery, off pain relief and mobile quicker than first time and honestly had no pain after about 10days where as last time I was still in pain for about 5months off and on. I really can’t recommend elcs enough!

Doctor here. 3a tear here, mild symptoms after but 100% opted for an elective second time. Seen too many women suffer to take the risk. Also looked at the "Green top guidelines" that obstetricians use and it quoted a
17-24% chance of symptoms getting worse after another vaginal delivery.
Recovery from my C section was sooooo much easier than my tear. Was driving within a week- and didn't have to carry around one of those sodding NCT tear cushions!!!!

I had a 3b with ds plus episiotomy. He was back to back and was a forceps delivery. I had a follow up appointment when ds was about 9 months and was advised to consider a elective csection for a second delivery. I've chosen not to have anymore kids but if I was to have a second, I would want a section.

@Littleguggi

The consultant did ask whether I'd refused physio - it was never offered! I got a bit upset because in the yer after DS was born I must've been to GP 6-8 times about problems with 'number twos' - he tested me for IBS, told me to eat LESS fibre, and gave me suppository for piles.
I never made the connection it was to do with tear, as didn't know it had torn that area!
I remember the day DS was born the consultant who delivered him came to see me in high dependency and did say I'd never have a vaginal birth again - which I thought he just said as a way to make me feel better!!

I have an almost identical birth story as you for my first. Similarly, when I was pregnant with ds2 I was going to go 'natural' and had it in my head that the problems I'd had first time round were my fault because I'd let them induce me etc

Midwives were really supportive about my choice to have another virginal birth. I saw the consultant who also gave me the same, stark warnings. As much as a section isn't a huge amount of fun, I thought it was the option I would regret least. Most of my family thought I was mad for even considering not having an elcs.

Anyway, I did have a section and had this weird, self induced guilt about it, but it wasn't so bad at all - much nicer than the first shit show.

Seven years down the line, I'm so pleased I did. Can't even tell I had a section (except for my battle scar )which actually makes me smile and think of ds2).

It's all a distant memory now so do what feels right and will make you the most comfortable. People will judge (and we unnecessarily judge ourselves) whatever we choose so you need to do what's right for you.

I find this interesting. I had a 3b with my first 5 years ago and am due in October. My consultant has advised that I don't need to consider a CS at all. He's not even given me any guidance or talked of risks etc.

I've read on the royal college of obstetricians website that the chances of a 3rd degree tear or above 1st time is 5%. The chances of a 3rd degree or above second time is 7.2% if you have already had a tear or 1.3% if you haven't.
I think it very much depends on the situation of the original tear.
I had a very fast birth (well a slow build up but active labour was less than 2 hours) so all my midwives have agreed that they think a more guided labour will provide a positive outcome. They've also advised perineal massage and really work on my pelvic floor muscles.
My mum had a 3rd degree first time and not even a graze 2nd time.

Hey @Frizzy1986

I think it depends on symptoms after - although I didn't have many issues, with pain etc, I did poo myself a few times (probably 3-4) in the 4 months after. And I did leak poo (sorry tmi) a couple of times for about 6-7 months - so its only because of this that consultant has recommended c-section.

That being said almost all of those issues were related to running, I started running again after 6 weeks. Looking back (I didn't know I'd had damage to my rectum/anus) I wouldn't have started running so soon and would've have done lower impact exercise.

The day my DS was born the consultant told me to do pelvic floor exercises everytime I breastfed, which I did religiously - and I've never had bladder incontinence, however - I never focused on 'bowel' muscles (which you can also train!) as didn't know they'd been damaged.

The consultant for this pregnancy has said if I opt for vaginal this time, they will pre-arranged physio on the nhs for me - whatever the outcome, so I'll likely recover quicker. I've also checked with my private health cover through work, they don't cover pregnancy care, but post-natal gynae stuff is covered - which would include pelvic physio and further surgeries if needed.

@backinaminute

This is exactly how I feel! Like I'm being a princess by considering a c-section!

I'm one of 9 children - so I can't get over my mum doing something 9 times, that I can't even handle twice!

That being said, my mum saw me in high dependency unit a few hours after I had ds and based on that wants me to go for c-section! Mainly as I looked on deaths door, but that was down to hemorrhage not the tear!

I had a 3rd degree tear with first. Was told immediately after delivery that I would need c-section next time (which was NOT the point that I was thinking about having more children 😂).

I had various physio appointments post birth and did pelvic floor exercises like I was training for the kegel olympics!! One medical professional told me it's fairly certain I'll have a prolapse one day.

I definitely struggled in the weeks/months afterwards. I couldn't control wees and I had no warning when I needed a poo. I thought I was going to have to live as a hermit for the rest of my life to avoid embarrassing situations in public.

Got much better over time and felt back to normal. When I got pregnant with second child I saw a consultant who gave me completely different advice to on here and said I was for a vaginal delivery. I went on to do so with no complications whatsoever. And the same again another time with no complications.

I know if I'd have read this thread I'd have been pushing for a csection though possibly but I just wanted to give the opposite side of having vaginal births after 3rd degree tear and honestly i feel great - I have no problems at all. Not even ones that seem to be accepted of women that gave given birth.

I think if you feel that you're still not quite right then I wouldn't do what I did but if you feel back to normal after your 3rd degree tear then I'd consider vaginal if you wanted too.

Good luck

@sianyb83 I didn't realise. I definitely think if there have been side effects its a whole other ballgame.
I've not had any bowel leaks but do suffer slight urine leaks sometimes (think trampolining activities) but this pregnancy I've noticed leaking due to the pressure inside. It's my own fault for not keeping up with my pelvic exercises though.
I've got an app this time and am doing a program of exercise each day.
Interesting what you say about training the other end too. My midwife told me at booking that they changed the advice of how to do your pelvic floor exercises since my last birth so you should clench the back first and pull through to your front which I guess is to cover both areas so that fits with what you said.

I have another consultant at 28 weeks as they didn't sign me off (even though he hardly spoke to me, told me there are no birth restrictions and I should just get to hospital faster) so I wonder if he'll ask more questions next time.

It's so sad that you feel like a CS is being a princess. You are doing what you think is best for your body. Does it matter how baby comes out? No one will ever give you a prize for having a VD. Dont put pressure on yourself because you feel that you will be judged.
I had a complicatio that required me to have a CS. Even if I didnt, there would be no question that I would be having an elective.
I was not happy to put my body through a VD. Every single person I know that had one has a horrific story to tell - prolapse, piles, tears etc. No thank you. This wasnt for me.
My mum had 4 kids with two being twins, all VD. No one gave her a prize for that, it was only important to her. I dont feel the need to do the same.
If you feel like a CS is a better option for you then go for it.

C section every time

I had a vaginal birth after 3c tear, tore again and now have serious issues

Honestly, don’t hesitate

Been there done that, 2nd degree first time 3rd degree second time. Third time round it was a c-section. Yes, it takes longer to recover and ‘get back to normal’ but it’s soooo much easier when the would can be kept clean and you haven’t caused yourself lifelong continence issues!

💐 for Almahart

3rd degree year for me first time round.

Booked for a section 2nd time round (decision helped by enormous baby) She came in 1hr 20 and there simply wasn't time for a section.

I ended up with a small tear and no issues.

I absolutely wouldn't hesitate to have a section in your position. No way I would risk a lifetime of incontinence and further issues. Trust your consultant. A few weeks of inconvenience vs a lifetime of issues, to me it's a no brained

'Brainer'

I had a 3a tear plus episiotomy and a 1.5l haemorrhage. My consultant has said he wouldn’t definitely advise CS for my next birth as the risk of a repeat tear is not that high.

Personally I would go for vaginal birth again because I hate the idea of CS (not a hypnobirthing type, just don’t like the idea of being cut open) and I’d rather take the risk and live with the consequences.

Basically another vaginal birth is rolling the dice - might be worse, might be better. A CS is a certainty. It’s really a personal choice as to which you choose.

Hi
I had a second degree episiotomy and some bowel problems after my first child . I had my second two years later and with hindsight I wish I'd had a C- section . I tore along the episiotomy site and although I seemed to heal ok I started having massive pelvic floor problems 5 years later , as I went into perimenopause . Basically my rectum ( and my womb!) decided they wanted to exit my body . Because if the damage is sustained to the back of my pelvic floor . It's taken major surgery and years of physio to get to the stable state I'm in now . I'd recommend a C section in order to avoid incontinence and pelvic floor problems . The problems don't always show themselves straight after birth .
Mx